Comprehensive-holistic rehabilitation programs (CHRP) have been consistently shown to be effective in improving psychosocial outcomes following TBI. The proposed symposium presents the theoretical foundations, clinical application, and research evidence for an innovative CHRP for individuals with TBI: Executive Plus (EP). First, the theoretical and conceptual foundation of EP will be presented. The EP model of CHRP integrates cerebral function, cognitive-behavioral and learning theories, and incorporates techniques from neurorehabilitation, psychotherapy, and psychoeducation. The model is based on three theoretically and empirically derived assumptions: 1) impaired executive functioning is related to poor problem-solving ability; 2) emotional dysregulation interferes with problem-solving ability; and 3) problem-solving and emotional regulation are mediated by attention. By utilizing bottom-up (i.e., restoration of function) and top-down (i.e., metacognitive strategy training), EP addresses impairments in both foundational (i.e., attention) and higher-order (i.e., executive functions) cognitive processes. The three core components of this model include problem-solving, emotional regulation, and attention training in both individual and group formats.
Next, we discuss the clinical application of EP, including patient selection, duration and format, manualization and treatment fidelity, therapist training, adverse events, and outcome assessment. Clinical case studies will be presented to illustrate the clinical application of EP.
Finally, the findings of a randomized controlled-trial (RCT) completed in the summer of 2010 comparing EP to a standard care CHRP will be presented. The results of the RCT indicate that participants in the EP program exhibited significant improvements in attention, problem solving, self-efficacy, and quality of life, at the 6-month follow-up assessment compared to participants in the standard care CHRP. Effect sizes ranged from .50 to 1 for the EP group, and from .06 to .57 for the standard care group. The findings suggest that skills taught in the EP program continued to facilitate improvement for several months following the end of treatment.